CVS Health
Overview
CVS Health is a leading health solutions company with a wide national presence. The Medical Director role is remote (work from home) with preference for candidates in Heartland states (ND, SD, NE, IA, W. MO, CO, KS) who hold an active medical license in one of these states. Responsibilities
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs and expand medical management programs to address member needs across the continuum of care. Support Medical Management staff ensuring timely and consistent responses to members and providers. Oversee utilization review and quality assurance; responsible for predetermination reviews and review of claim determinations. Handle Prior Authorization, Pre Certification, Concurrent Reviews, Peer-to-Peer Calls, First Level Appeals, and participate in Special Projects and Committees when needed. Provide clinical, coding, and reimbursement expertise and direct case management when necessary. Offer clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Act as lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs by clinical teams. Required Qualifications
Five (5) or more years of experience in Health Care Delivery System (e.g., Clinical Practice and Health Care Industry). Active and current medical license without encumbrances. M.D. or D.O., with Active and Current Board Certification in an ABMS or AOA-recognized specialty including post-graduate direct patient care experience. Preferred Qualifications
Previous UM experience with a Health Plan/Payor/Physician Advisor in a healthcare system. Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Med/Peds/General Surgery is preferred. Education
Medical Doctor or Doctor of Osteopathic Medicine Pay Range
The Typical Pay Range For This Role Is $174,070.00 - $374,920.00. This range represents the base salary for positions at this level. Actual offer depends on experience, education, geography, and other factors. Eligible for CVS Health bonus/commission or short-term incentive program plus equity award opportunities. Benefits
Affordable medical plan options, a 401(k) plan (including matching contributions), and an employee stock purchase plan. No-cost programs for wellness, tobacco cessation, weight management, confidential counseling, and financial coaching. Benefit options addressing different needs, including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and other eligible benefits. For more information, visit https://jobs.cvshealth.com/us/en/benefits Application window: We anticipate the opening will close on 09/30/2025. Qualified applicants with arrest or conviction records will be considered in accordance with all applicable laws. Seniority level: Director Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health.
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CVS Health is a leading health solutions company with a wide national presence. The Medical Director role is remote (work from home) with preference for candidates in Heartland states (ND, SD, NE, IA, W. MO, CO, KS) who hold an active medical license in one of these states. Responsibilities
Provide oversight for medical policy implementation. Participate in the development, implementation, and evaluation of clinical/medical programs and expand medical management programs to address member needs across the continuum of care. Support Medical Management staff ensuring timely and consistent responses to members and providers. Oversee utilization review and quality assurance; responsible for predetermination reviews and review of claim determinations. Handle Prior Authorization, Pre Certification, Concurrent Reviews, Peer-to-Peer Calls, First Level Appeals, and participate in Special Projects and Committees when needed. Provide clinical, coding, and reimbursement expertise and direct case management when necessary. Offer clinical expertise and business direction in support of medical management programs through participation in clinical team activities. Act as lead business and clinical liaison to network providers and facilities to support effective execution of medical services programs by clinical teams. Required Qualifications
Five (5) or more years of experience in Health Care Delivery System (e.g., Clinical Practice and Health Care Industry). Active and current medical license without encumbrances. M.D. or D.O., with Active and Current Board Certification in an ABMS or AOA-recognized specialty including post-graduate direct patient care experience. Preferred Qualifications
Previous UM experience with a Health Plan/Payor/Physician Advisor in a healthcare system. Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or Med/Peds/General Surgery is preferred. Education
Medical Doctor or Doctor of Osteopathic Medicine Pay Range
The Typical Pay Range For This Role Is $174,070.00 - $374,920.00. This range represents the base salary for positions at this level. Actual offer depends on experience, education, geography, and other factors. Eligible for CVS Health bonus/commission or short-term incentive program plus equity award opportunities. Benefits
Affordable medical plan options, a 401(k) plan (including matching contributions), and an employee stock purchase plan. No-cost programs for wellness, tobacco cessation, weight management, confidential counseling, and financial coaching. Benefit options addressing different needs, including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and other eligible benefits. For more information, visit https://jobs.cvshealth.com/us/en/benefits Application window: We anticipate the opening will close on 09/30/2025. Qualified applicants with arrest or conviction records will be considered in accordance with all applicable laws. Seniority level: Director Employment type: Full-time Job function: Health Care Provider Industries: Hospitals and Health Care Referrals increase your chances of interviewing at CVS Health.
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